Introduction
Recent developments in drug therapy have improved the disease activity of rheumatoid arthritis (RA). These developments include the administration of conventional synthetic disease-modifying anti-rheumatic drugs (DMARDs), biological DMARDs, and targeted synthetic DMARDs.1 However, the progression of joint destruction in the lower extremities remains a major problem in clinical settings.2
In previous reports, the incidence of ankle involvement in joint destruction ranged from 4% to 90%.3–6 In the Korean registry, 29% (598/2046) of patients with RA had foot and/or ankle arthritis, with greater severity of disease activity and lower remission rate compared with those without foot and/or ankle RA.6 In the United Kingdom registry, 35.4% (207/585) of patients reported current foot pain as the presenting symptom.4 Most studies report a high prevalence of foot and ankle involvement in patients with RA. Yano et al. reported that patients with RA and foot impairment had higher disease activity and lower activities of daily living than those without foot impairment.7
The elderly population with RA includes both patients with elderly-onset RA (EORA), in which the disease manifests after the age of 60 years, and individuals diagnosed with RA early in life (young-onset RA or YORA). There are treatment concerns for the older adult population group, as RA drugs can induce several age-related adverse events.8In addition, the reversibility of functional impairments is reduced in older patients with RA due to age-related factors or comorbidities.9
In the KURAMA cohort (a Japanese cohort of patients with RA), patients with EORA showed higher bone erosion than patients with YORA.10 Furthermore, complaints of ankle deformity and functional disability were higher in patients with EORA.
When ankles are deformed by RA, both the talocrural and subtalar joints are damaged, and ankle arthrodesis using a retrograde intramedullary ankle nail is the surgical procedure of choice.11−16
Here, we present two cases of patients with RA who presented with highly destructive changes in the ankle joint. We performed retrograde intramedullary nail fixation surgery in both patients, which resulted in good functional outcomes.